POS0518 TREATMENT OF GOUT AND ITS EFFECTS ON METABOLIC SYNDROME
Authors: R. Kuppuraju, P. May, T. Millliken, S. Kitancho, D. Bulbin
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> There is a known relationship between elevated serum urate (SUA) levels and renal, cardiovascular (CV), and metabolic disease. However, the precise reasons for this remain poorly defined. The CANTOS trial found a significant decrease in nonfatal MI, stroke, or CV death in patients (PTs) treated with canakinumab vs placebo. The LoDoCo2 trial found a decrease in CV death, nonprocedural MI, ischemic stroke, and ischemia-driven need for coronary revascularization in PTs treated with colchicine vs placebo. This suggests that inflammation is an independent risk factor for CV disease. The GOSPEL 4 trial found that French PTs with early-onset gout (EOG), a diagnosis (DX) &lt; age 40, had slightly more arthritis, significantly less chronic stage 3 or 4 kidney disease (CKD) compared to common gout (CG) PTs, DX ≥ age 40. Metabolic syndrome was significantly more prevalent in the CG group. To our knowledge, no study has investigated the effects of EOG vs CG on incidence of metabolic-related diseases in a rural population in the US. <h3>Objectives</h3> To investigate whether early DX and control of gout results in lower incidence of metabolic-related diseases in a rural setting. <h3>Methods</h3> We conducted a retrospective analysis of PTs with gout at a rural tertiary care center. We identified PTs seen Jan 2016-Dec 2020 with a gout DX. Charts were reviewed for: sex; age at DX; age at the time of gout DX and at the last medical encounter; HbA1c level; SUA level; and BMI. Charts were reviewed for urate-lowering therapy (ULT) prescriptions, atherosclerotic cardiovascular disease (ASCVD)/peripheral arterial disease (PAD), diabetes mellitus (DM), hypertension (HTN), and CKD. We compared demographic and clinical characteristics between EOG and CG PTs using chi-square tests for categorical data and the Kruskal-Wallis test. All analyses were performed using SAS version 9.4. <h3>Results</h3> For baseline demographics, see Table 1. Of 12,362 charts reviewed, 692 had EOG, and 11,670 had CG. More PTs in the CG group had ASCVD/PAD (4.6% vs 0.3%, p &lt;.0001), DM (38.2% vs 15.5%, p &lt;.0001), HTN (83.8% vs 44.9%, p &lt;.0001), CKD (43.4% vs 7.1%, p &lt;.0001), and tophi (5.3% vs 0.0%, p &lt;.0001). CG PTs had higher mean initial HbA1c (6.5 vs 6.1, p &lt;.0001) and last HbA1c (6.1 vs 5.6, p &lt;.0001). PTs in the EOG group had higher mean initial SUA levels (8.2 vs 7.1, p &lt;.0001) and last SUA levels (7.5 vs 6.3, p &lt;.0001). There was no significant difference in ULT use (72.6% vs 71.1%, p = 0.3856). <h3>Conclusion</h3> Our study suggests PTs with EOG had significantly lower rates of ASCVD/PAD, DM, CKD, tophi and lower A1c levels. Given that EOG and CG patient's ULT use was similar, this shows that EOG PTs on ULT are less likely to develop the comorbidities associated with gouty arthritis. We further intend to look at EOG time to comorbidity DX event. <h3>References</h3> [1]Nidorf SM et al. Colchicine in PTs with Chronic Coronary Disease. N Engl J Med. 2020;383(19):1838-1847. doi:10.1056/NEJMoa2021372 [2]Pascart T, et al. PTs With Early-Onset Gout and Development of Earlier Severe Joint Involvement and Metabolic Comorbid Conditions: Results From a Cross-Sectional Epidemiologic Survey. Arthritis Care Res (Hoboken). 2019;71(7):986-992. doi:10.1002/acr.23706 [3]Ridker PM et al. Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease. N Engl J Med. 2017;377(12):1119-1131. doi:10.1056/NEJMoa1707914 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.